Ayahuasca Retreat Registration

Ayahuasca retreat January 11 - 20, 2027 registration form (Group led by Luz)

  • Basic information

  • If you don't have your passport yet, please fill "0" and give us your passport number later.
  • Health condition

  • Enter "none" if you are not currently using any recreational drugs.
    I understand that ayahuasca and all other sacred plants are purgatives and dangerous to consume while pregnant. If I become pregnant before the beginning of the tour, I understand that I am responsible for notifying Feather Crown and that I will not be able to ingest ayahuasca or any other sacred plant during pregnancy. I also understand that I will not be entitled to a refund.
  • Feather Crown Health Screening and Full Disclosure:

  • This retreat involves the ingestion of plant medicines that may be contraindicated with certain medical conditions, medications, or substances. All herbal supplements, natural medicines, and medications (prescription and over-the-counter) taken within 30 days prior to the retreat, as well as during the retreat, must be fully disclosed to Feather Crown before the retreat begins. No medications, supplements, or natural remedies may be taken during the retreat without the express written permission of Feather Crown. By completing this application, you confirm that all information provided is true, complete, and current, and that you have fully disclosed all physical and psychological conditions, as well as all medications, supplements, and substances you are taking.
  • Feather Crown Medical Responsibility and Liability Waiver

  • By checking the box below and typing my name, I confirm that: I have read and understood all provided medical and safety information I have fully disclosed all requested health and medical information All information I have provided is true and complete to the best of my knowledge I understand that: Falsifying or omitting relevant information may result in denial of participation, with or without refund, at the sole discretion of Feather Crown Ayahuasca and other plant medicines may be dangerous or life-threatening if combined with certain conditions or substances Feather Crown is not a medical facility Its owners, staff, employees, and agents do not practice Western medicine and are not licensed medical doctors I voluntarily assume full responsibility for my participation. I hereby waive, release, and hold harmless Feather Crown, its owners, staff, employees, and agents from any and all liability, claims, damages, or injuries that may occur in connection with my participation.
  • Food, accommodation and transportation

  • Please check the following fields if you want us to organize private transport for you on the 1st day of the retreat, and/or the last one. We can pick you up at your hotel in Quito, or at the Mariscal Sucre airport near Quito, or in Tababela (a town close to the airport). Please note that the price may differ according to how many people are requesting transport, but will not exceed $120 USD per person.
  • Work with the plants

  • How did you hear about Feather Crown? If it was from a website, which one? Thank you for helping us to understand how people find us.
  • Anything that you want to add:
  • Make sure we receive your registration:

    After you hit the submit button, you should receive an immediate confirmation email. If you don't receive the confirmation email within few minutes, something went wrong with your submission and you need to resend it. Make sure you fill all the obligatory fields, otherwise it won't let you send the form. You can always contact us at info@feathercrown.com if you have any problem.

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